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Published on: February 17, 2023
Isolated rectal bleeding in neonates: a scoping review
Alexandra Markevich1, Júlia G Botelho2, Luana L Morikawa2
1Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas (FCM), Department of Pediatrics, Campinas, SP, Brazil.
Objective:
To review the etiological factors that cause isolated rectal bleeding in otherwise asymptomatic neonates.
Data Source:
A scoping review was conducted following PRISMA-adapted guidelines. The databases consulted included PubMed, PubMed Central, BVS, Scopus, Embase, Web of Science, Cochrane, PROQUEST, and EBSCOHOST, with no language or publication period restrictions. The authors reviewed studies of any methodological design, including neonates up to 28 days of life with visible blood in the stool, with no symptoms of disease.
Summary Of The Findings:
A total of 1,287 articles were identified, and 749 duplicates were removed. After screening the title and abstract, 139 studies were selected for full-text review, of which 56 were included. The data included 1,154 neonates. The diagnoses, in decreasing frequency order, were isolated rectal bleeding (IRB), cow's milk protein allergy (CMPA), swallowing maternal blood, hemorrhagic colitis, intestinal infections, and nodular lymphoid hyperplasia. Around 22% of patients diagnosed with CMPA underwent oral food challenge to confirm the diagnosis.
Conclusions:
Most of the reviewed articles presented case reports or observational case series. The main cause of rectal bleeding in otherwise asymptomatic neonates was the descriptive diagnosis of isolated rectal bleeding, which evolved benignly and spontaneously. The second most frequent cause was CMPA, though most cases were not confirmed by an oral food challenge. IRB in neonates has been managed without standardized protocols for investigation or treatment.